Administration and Policy in Mental Health and Mental Health Services Research最新文献

Implementation climate is a key determinant of successful adoption (Ehrhart et al. in Evid Based Nurs 18(2):85–92, https://doi.org/10.1111/wvn.12500, 2014). Previous studies examined the Implementation Climate Scale (ICS) across diverse contexts, with mixed findings on its factor structure, particularly concerning the Rewards for EBP subscale (Ehrhart et al. in Child Abuse Neglect 53:17–26, https://doi.org/10.1016/j.chiabu.2015.10.017, 2016, Subst Abuse Treat Prev Policy 14(1):35, https://doi.org/10.1186/s13011-019-0222-52019, 2019, Peters et al. in BMC Health Serv 22(1):1–11, https://doi.org/10.1186/s12913-021-07441-w, 2022, Lyon et al.in Implement Sci 13:1–14, https://doi.org/10.1186/s13012-017-0705-6, 2018; Engell et al. in Child Youth Serv Rev 119:105509, https://doi.org/10.1016/j.childyouth.2020.105509, 2020). This study replicated and extended prior research by evaluating the psychometric properties of the ICS in a sample of 255 participants in a community-based learning collaborative that trained providers in Trauma-Focused Cognitive Behavioral Therapy and Trauma-Focused Case Management. Confirmatory factor analyses assessed the original six-factor structure, a five-factor model omitting the Rewards for EBPs subscale, and second-order latent factor models. Both six- and five-factor models demonstrated acceptable fit; however, the five-factor model was selected due to the Rewards subscale’s poor endorsement, weak correlations, and limited relevance in community mental health settings. A chi-square difference test between the five-factor first- and second-order models revealed no significant difference in fit (χ²diff(5) = 11.01, p > .05), supporting the use of the five-factor second-order structure given comparable fit and the theoretical advantage of an ICS total score. These findings validate the use of the ICS in community mental health settings across provider types and suggest that omitting the Rewards subscale may improve applicability and interpretability, particularly in resource-limited environments. Future research should further explore alternative incentive structures in resource-limited contexts and examine the impact of policy and financial incentives on the perceived relevance of the Rewards subscale.

Economic evaluations can be a powerful tool to assist policymakers in prioritizing interventions to reduce the number of suicides. However, the number of economic evaluations of suicide prevention is low and their quality vary. The aim of this paper is to review the literature on economic evaluations for suicide prevention, specifically focusing on the methods used to measure and value the effect of interventions. To identify articles, we searched PubMed, Web of Science and Scopus for the period from 2000 to 2023. Since the aim was to investigate how a reduction in the number of suicides is measured and valued when evaluating suicide prevention interventions, we only included studies containing effects on mortality. In total 560 unique hits were identified. Most studies were excluded after the first screening of abstracts and titles. The most common reason for exclusion was that the study did not evaluate an intervention for suicide prevention. The final analysis included 16 studies. The number of economic evaluations of suicide prevention is still low, but there is a positive trend and methodological improvements have been made. Nevertheless, several areas where more research is needed were identified, regarding both how to measure and value the effect.

The Modular Approach to Therapy for Children (MATCH) consists of individual evidence-based components (modules) that clinicians can flexibly select to target a range of emotional and behavioral symptoms. The treatment manual includes flowcharts that outline a sequence of modules recommended for each problem area: anxiety, depression, and conduct problems. This study explored the use of modules and associations with outcomes for youths who received MATCH in routine clinical care. The sample included 964 youths ages 3–17 (51% female, 52% White, 35% Hispanic, 9% Black) with primary anxiety, depression, or conduct problems. Youths typically received modules from the MATCH flowchart for their primary problem as well as some modules from other problem areas. The use of more modules from the flowchart for the youth’s primary problem predicted greater clinician-rated improvement (Clinical Global Impressions-Improvement; CGI-I). In addition, youths with primary depression improved more when they received more modules from the anxiety flowchart and youths with primary conduct problems improved more when they received more modules from the depression flowchart, based on the CGI-I at the last timepoint. Providing more modules from the flowchart for a youth’s primary problem area predicted the severity of top problems (Top Problems Assessment; TPA) at the last timepoint for youths with primary depression (based on caregiver and youth report) and primary conduct problems (based on caregiver report). Results suggest that clinicians should generally use modules from the flowchart for the youth’s primary problem and incorporate modules from other problem areas to address additional concerns as needed.

The global demand for mental health services exceeds available resources, particularly in low- and middle-income countries where access remains limited. Even in high-resource nations, many individuals still lack adequate care, a gap exacerbated by the COVID-19 pandemic. Brief psychological interventions (BPIs) offer a structured, short-term therapeutic approach to address this need. Typically delivered in fewer than ten sessions, BPIs incorporate evidence-based therapy components and can be administered by paraprofessionals, non-credentialed individuals trained to provide mental health support. This review synthesizes research on paraprofessionally delivered BPIs by describing study characteristics across populations, settings, and intervention modalities, characterizing the paraprofessional workforce, and summarizing reported mental health outcomes and patterns of effectiveness. A PsycINFO and PubMed search identified 47 articles, including 45 unique studies. To provide a clearer picture of effectiveness, box-score analyses were conducted on randomized controlled trials (RCTs) and pilot/feasibility RCTs. Findings indicate that paraprofessional-delivered BPIs, particularly those grounded in cognitive-behavioral therapy (CBT) and delivered remotely, are consistently effective across diverse populations and contexts. The evidence base is strongest for adult populations and posttraumatic stress disorder (PTSD) outcomes, with weaker support for adolescents and school-based programs. Paraprofessionals’ cultural and community alignment also enhanced engagement and reduced stigma-related barriers. Nonetheless, inconsistencies in training, supervision, intervention fidelity, and recruitment criteria present challenges for scalability. This review highlights the absence of a rigorously tested definition of BPIs and the lack of consensus on the term paraprofessional. It underscores the need for standardized training and supervision guidelines to ensure fidelity and sustainability. Further research is essential to refine best practices and optimize paraprofessionals’ integration into mental health systems, thereby improving accessibility and equity.

Temporary mental health (MH) staffing gaps are common and may compound access challenges due to increasing demand for MH care combined with a shrinking MH workforce. In 2019, the Veterans Health Administration (VA) implemented a system of 18 regionally based Clinical Resource Hubs (CRHs) staffed with remote providers delivering virtual MH care. While the program demonstrated promise during early implementation for effectively addressing some access challenges, its sustainment may depend partly on leaders’ perceptions of its ability to meet and adapt to access-related priorities. Our aim was to explore and describe how VA regional MH leadership identified and weighed values of the CRH during early implementation, and how it might have functioned beyond filling temporary staffing gaps. We conducted semi-structured interviews with CRH MH leaders (n = 36) across all 18 VA administrative regions. We analyzed data using a rapid qualitative approach that included templated summaries and matrix analysis. Three key perceived values of the CRH were identified: (1) its potential to offer a more integrated care experience than community (VA-purchased) care in some cases, (2) its ability to provide specialized MH services (e.g., suicide prevention) to rural areas and, (3) its capacity to improve MH provider recruitment and satisfaction. Virtual care delivered through the CRH can be a flexible option for maintaining access to MH services during staffing shortages. MH leaders’ perspectives suggest the CRH program is not only a contingency staffing solution to access problems, but provides additional values that could be leveraged to improve MH care services more generally.

Trauma exposure is prevalent among youth and associated with adverse outcomes. While evidence-based treatments (EBTs) for trauma-exposed youth exist, widespread dissemination into community practice is challenged by clinicians’ abilities to engage in EBT training. These challenges stem from many individual, agency, and neighborhood-level factors. This study utilized data from 231 therapists who participated in a statewide Learning Collaborative (LC) on TF-CBT to explore how individual, agency, and neighborhood-level factors may influence their level of participation in the training requirements. Preliminary results indicated that agencies in resource-deprived neighborhoods were associated with having therapists with more PTSD experience, but also reduced interagency collaboration and less use of agency-level trauma-informed practices. In contrast, therapists in neighborhoods with higher violent crime rates were reported to have less experience with trauma-exposed youth, yet their agencies had fewer reported community barriers, increased interagency collaboration, and more agency-level trauma-informed care. Finally, agency-level correlates of LC training participation suggest that agencies face a delicate balance in managing different aspects of evidence-based practices (EBPs) care and EBTs. Findings emphasize considering contextual factors when disseminating EBTs, as ensuring an optimal environment for training participation ultimately addresses growing mental health disparities for trauma-exposed youth.